31.7% of Kentucky prisoners are African American
By Whitney Harder
University of Kentucky News
LEXINGTON, Ky. (Nov. 12, 2015) — When Danelle Stevens-Watkins was completing her post-doctoral year as a visiting assistant professor seven years ago in counseling psychology at the University of Kentucky, she was exposed to something that would impact her entire career trajectory.
“I saw a need I had never seen before,” she said.
While being mentored by Carl Leukefeld, professor and chair of the UK Department of Behavioral Science, and Carrie Oser, associate professor of sociology and co-director of the Health, Society and Populations Program, Stevens-Watkins learned through research and clinical experiences about significant health disparities in the African-American community, particularly HIV and drug abuse.
“It’s become a crisis in the African-American community,” Stevens-Watkins said.
According to the Centers for Disease Control and Prevention, African Americans are the racial/ethnic group most affected by HIV in the United States, and substance use has been closely associated to the disease since the epidemic began.
Individuals who are incarcerated are also at increased risk for acquiring and transmitting HIV, and African Americans are disproportionally represented in the prison population. The Kentucky Commission on Human Rights reported in 2010 that while African Americans make up only 7.7 percent of the state’s population, 31.7 percent of the total prison population in Kentucky is African American.
To combat these health disparities, Stevens-Watkins, now a licensed psychologist and associate professor in the UK College of Education’s Department of Educational, School, and Counseling Psychology, began research on them. And not only to collect data that could yield important findings, but to test a new way of helping incarcerated men.
She is currently leading a National Institute on Drug Abuse (NIDA) funded project studying mental health, HIV risk and drug use among African-American male prisoners at Blackburn Correctional Complex in Lexington and Luther Luckett Correctional Complex in Lagrange, Kentucky, specifically those who will soon reenter into the community.
“The community re-entry period can be a stressful time for incarcerated men, placing them at risk for substance use disorders, mental health problems, and HIV risk behaviors,” Stevens-Watkins said. “Many of the men we have interviewed have never been tested for HIV.”
In April, Stevens-Watkins and her research assistants began conducting interviews with around 200 men reentering into Fayette County and Jefferson County or scheduled to appear before the parole board within the next 90 days. Only they were not asking the questions. Instead, Audio Computer Assisted Self Interview (ACASI) software presents the questions, helpful when interviews include sensitive topics about mental health, drug use and risk behaviors.
“Sometimes, the data you get from asking very personal questions can be invalid” she said. “ACASI is a really unique feature that should allow them to feel comfortable giving honest answers, and if they need any assistance, someone is still available.”
ACASI has also allowed men with literacy issues to participate in the study as the questions are presented through audio recordings instead of written prompts.
More recently, Stevens-Watkins received the UK Center for Clinical and Translational Science (CCTS) Junior Investigator Award for a related project. The award is funding a pilot study within the NIDA study, and will test a new HIV prevention method. During the consent process for the NIDA study, her team will ask those participants if they are also interested in participating in the pilot study, which will involve around 80 individuals.
“It’s really neat because of our relationship with Dr. Carl Leukefeld in the College of Medicine and Department of Behavioral Sciences, who has a long-standing relationship with the Kentucky Department of Corrections,” Stevens-Watkins said. “They are very enthusiastic about allowing us to come in and do this program.”
The CCTS pilot study, conducted at Blackburn, will include two groups, the “treatment as usual” group, who will receive mental health screeners and a basic HIV education component, and the “intervention” group, employing a new prevention method.
The mental health screeners will assess for symptoms of anxiety, depression and post-traumatic stress disorder, which Stevens-Watkins notes is severely undiagnosed among African Americans in general and particularly among African-American prisoners reentering the community.
“We hope that these mental health screeners will help raise awareness, and we can actually inform the participants that they do or do not meet the criteria for certain mental health diagnoses,” she said.
Each participating individual will have the option for free HIV testing, a unique aspect within itself as Kentucky does not require HIV testing for incarcerated individuals. Anyone participating in the NIDA parent study will also have the option for free HIV testing.
“For anyone that tests positive, we will counsel them, encourage them to seek services at the prison, and do any further therapy needed,” Stevens-Watkins said. “One of the reasons why this project is so near and dear to my heart is that I am a licensed psychologist, and it offers that opportunity to provide that support.”
As for the education component, Stevens-Watkins and her team will deliver the most up-to-date HIV education, approved by NIDA and the Centers for Disease Control and Prevention, reviewing with participants what HIV is and distinguishing it from AIDS; how HIV is transmitted; and ways to prevent exposure to themselves and others.
Unlike the “treatment as usual” group, the “intervention” group will go beyond the basic HIV education and for the first time will implement culturally adapted “Real Men Are Safe” (REMAS-CA) workshops in a prison. REMAS is a group-level, clinic-based behavioral intervention that has been shown to reduce HIV/STI risk, but Stevens-Watkins and her team will use a version revised for African-American incarcerated men. To date, her research team has enrolled 40 men in the CCTS pilot study.
“Theoretically, people have the basic knowledge of how HIV is transmitted and how to protect themselves, but we see time and time again that the knowledge doesn’t necessarily translate into behavior change,” she said. “So we are hoping that this particular culturally adapted intervention could break that barrier, taking culture into context, as opposed to using basic, universal HIV education.”
Three months after the participants are released from Blackburn, Stevens-Watkins will follow-up with them, asking about drug use, mental health status, risk behaviors, and conduct drug screenings and HIV testing. From there, she will be able to see how effective the culturally adapted REMAS prevention was compared to the standard education.
Stevens-Watkins will also consider how feasible it is to conduct these education and intervention sessions in a prison setting. If it is feasible, her research could potentially change the entire reentry model for HIV prevention in high risk groups.
“This is my home so I feel a compelling passion to serve those here in my home state, as a clinician and as a researcher,” she said.